Joukamaa M.

Kaltiala-Heino R

Korkeila J

Lehtinen V

Protshenko J

Tuohimäki C

English

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Psychiatric inpatients' views on self-determinationCarita TuohimaÈkia,*, Riittakerttu Kaltiala-Heinob, Jyrki Korkeilac,Juri Protshenkoa, Ville Lehtinend, Matti JoukamaaeaResearch Scientist, Department of Psychiatry, University of Oulu, Peltolantie 5, FIN-90210 Oulu, FinlandbSenior Assistant Professor, Tampere School of Public Health, University of Tampere, Tampere, FinlandcResearch Scientist, Kupittaa Hospital, Turku, FinlanddResearch Professor, National Research and Development Centre for Welfare and Health, Helsinki, FinlandeProfessor, Department of Psychiatry, University of Oulu, Oulu, Finland1. IntroductionPatients' right to participate in decision-making about their treatment is increasingly moreemphasised in modern Western society. Traditionally, the treatment relationship between adoctor and the patient was paternalistic: the doctor, with professional competence, wassupposed to know best what is good for the patient, and the patient was expected to agree tothe treatment plan presented by the doctor (Cahn, 1980). Nowadays, however, the doctor±patient relationship is seen more as a contract between equal parties who negotiate about thetreatment. In many countries the legislation has been changed, which supports this tendency(Kaltiala-Heino, 1995). The doctor has the professional expertise but the patients are the bestexperts on their own lives and preferences. The modern medical and surgical treatments arefar more effective than traditional treatments, but the risks of harmful side effects are also fargreater (Hamilton, 1983). Patients can expect greater success in treatment, but also mustknow they face greater risks (Draper & Dawson, 1990).Involuntary psychiatric treatment is an exception in the general development towardspatients' rights to decide about their treatment. The justification for this exception is the claimthat mental illness impairs the patient's capacity to understand the consequences of his/heractions out and the benefit of the offered treatment. Within the last years, a consensus hasdeveloped that mental illness and decision-making incapacity are not necessarily synonymous(Zaubler, Viederman, & Fins, 1996). To be competent to decide, a patient must be able tounderstand information, appreciate information as relevant to her/his own situation, reasonwith information and express a choice (Appelbaum & Grisso, 1988, 1995). Mental illness* Corresponding author. Tel.: +358-8-315-7378 or +358-40-575-5336; fax: +358-8-333-167.E-mail address: carita.tuohimaki@pp.inet.fi (C. TuohimaÈki).International Journal of Law and Psychiatry24 (2001) 61±690160-2527/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved.PII: S0 1 6 0 - 2 5 2 7 ( 0 0 ) 0 0 0 6 7 - 4

Psychiatric inpatients' views on self-determination

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Psychiatric inpatients' views on self-determination

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